Information Collection

Form T and instructions

IC 45940 under ICR 200710-1212-001 · OMB 1212-0064.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1212-0064 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form T Form T and instructions	Form and Instruction
T TERMINATION PREMIUM DECLARATION Form T package.pdf	Form and Instruction

IC Title:

Form T and instructions

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 29 CFR 4000, 4007 (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	T	TERMINATION PREMIUM DECLARATION	Form T package.pdf		No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 30

Number of Respondents for Small Entity: 8

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to New Statute
Annual Number of Responses for this IC	50	50
Annual IC Time Burden (Hours)	40	40
Annual IC Cost Burden (Dollars)	264,000	264,000

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.